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Would Improving Palliative Care Get Rid of Patient Requests for Aid-in-Dying?

PRO (yes)

CON (no)

Kathleen Foley, MD, Professor in the Department of Neurology at Weill Medical College of Cornell University and Herbert Hendin, MD, Professor in the Department of Psychiatry and Behavioral Sciences at the New York Medical College, wrote in the introduction to their 2002 book, The Case Against Assisted Suicide: For the Right to End-of-Life Care:

"Opposition to legalization [of assisted suicide and euthanasia] is strongest among physicians who know most about caring for terminally ill patients (i.e., palliative care specialists...). They know that patients requesting a physician's assistance in suicide are usually telling us as strongly as they know how that they desperately need relief from their suffering and that without such relief they would rather die. They are making an anguished cry for help and a very ambivalent request to die. When they are treated by a physician who can hear their ambivalence, understand their desperation, and relieve their suffering, the wish to die usually disappears."

Edmund Pellegrino, MD, Professor Emeritus of Medicine and Medical Ethics at Georgetown University Medical Center, wrote in the chapter "The False Promise of Beneficent Killing," that appeared in his 1998 book Regulating How We Die:

"Most often, the request for euthanasia or assisted suicide is a plea for help in dealing with suffering as much as pain... The combined and integrated relief of pain and suffering shaped to suit the peculiarities of their manifestation in each person is the aim of comprehensive palliative care and the more sophisticated hospice regimens. Patients treated this way usually do not ask for termination of their lives; when they do ask for it, they tend to change their minds later. It is an injustice to offer these patients assisted suicide or euthanasia as options when so much more can be offered in the way of sophisticated treatment."

The American Geriatrics Society wrote in their Position Statement, "Physician-Assisted Suicide and Voluntary Active Euthanasia," last updated in Nov. 2002:

"It is the general consensus of the AGS [American Geriatrics Society] that most individuals who consider PAS [physician-assisted suicide] or VAE [voluntary active euthanasia] do so out of fear of the dying process. The vast majority of patients can be comfortable (which might require sedation) and potentially could find meaning in the last phase of life and choose to forgo a life-sustaining treatment and accelerate dying. All of these options for care, are already legal. Most would choose to live if they had full confidence that the care system would serve them well. A thorough search for the underlying reason for the request for death may uncover several areas amenable to potential interventions (e.g., undertreated physical symptoms, psychosocial or spiritual crisis, clinical depression, etc.)."

Wesley Smith, JD, Anti-Euthanasia Activist, wrote in his 1997 book Forced Exit:

"If we want to create a truly humane health-care system that cares for people rather than killing them, pain control must be made universally available... For pain that average doctors cannot overcome, all H.M.O.s must be required to make referrals to board-certified pain-control experts readily available to plan members without arbitrary restriction, on an as-needed basis. In that way, suffering people such as Rebecca Badger, Jack Kevorkian's thirty-third victim, who stated in a presuicide television interview that she would prefer to life if she could escape the pain, would be able to obtain relief without resorting to death peddlers."

Gerrit Kimsma, MD, Associate Professor in Medical Philosophy at the Center for Ethics and Philosophy at Vrije Universiteit, Amsterdam, and Evert van Leeuwen, PhD, Professor in Philosophy and Medical Ethics at the Center of Ethics and Philosophy at the Vrije Universiteit Medical Center, Amsterdam, wrote in the chapter "Assisted Death in the Netherlands: Physician at the Bedside When Help Is Requested," that appeared in their 2004 book Physician-Assisted Dying: The Case for Palliative Care & Patient Choice:

"Despite evidence that the number of euthanasia cases has stabilized over the past six years with improvements in palliative care, twelve years of research on issues of end-of-life care indicate no increase in the number of physicians who believe that 'adequate treatment of pain and counseling the dying' can eliminate the need or desire for euthanasia."

Timothy Quill, MD, Professor of Medicine, Psychiatry, and Medical Humanities at the University of Rochester School of Medicine and Dentistry, wrote in the chapter "Death and Dignity--A Case of Individualized Decision Making" that appeared in his 1995 book Arguing Euthanasia:

"Although I know we have measures to help control pain and lessen suffering, to think that people do not suffer in the process of dying is an illusion. Prolonged dying can occasionally be peaceful, but more often the role of the physician and family is limited to lessening but not eliminating severe suffering.

I wonder how many families and physicians secretly help patients over the edge into death in the face of such severe suffering. I wonder how many severely ill or dying patients secretly take their lives, dying alone in despair. I wonder...whether the Hemlock Society's way of death by suicide is the most benign."

Erich Loewy, MD, Professor and Endowed Alumni Association Chair (emeritus) of the Bioethics Program at the University of California, Davis Medical Center, wrote in the chapter "Harming, Healing, and Euthanasia," that appeared in his 1998 book Regulating How We Die:

"The better our care of terminal patients, the less will be the need for euthanasia. Orchestrating death by giving as much content and meaning to the last stage of living as to every other stage, rather than focusing on dying, can do much to reduce the need for euthanasia. Nevertheless, the need for active euthanasia will not vanish. Inevitably, part of good 'orchestration' of a patient's last days may require euthanasia or assisted suicide."

Marcia Angell, MD, Senior Lecturer in the Department of Social Medicine at Harvard Medical School, wrote in "The Quality of Mercy," which appeared in the July 11, 2006 edition of The Willits News:

"Death is not fair and it is often cruel. Some die young, others in extreme old age. Some die quickly, others die slowly but peacefully. Some find personal or religious meaning in the process, as well as an opportunity for a final reconciliation with loved ones. Others, especially those with cancer, AIDS, or progressive neurological disorders, die by inches and in great anguish. Good palliative care usually can help in these cases, but not always, and often not enough.

The problem is not just pain, although that can be devastating. Other symptoms, such as breathlessness and nausea, can be worse and even harder to relieve. There are no good treatments for weakness, loss of bodily functions, and helplessness probably the most important reasons for despair in those who are dying slowly, along with the knowledge it can only grow worse...

There is no right way to die, and there should be no schism between advocates for better palliative care and advocates for making it possible to hasten death with a physician's help. Good palliative care and the right to make this choice are no more mutually exclusive than good cardiologic care and the availability of heart transplantation. To require dying patients to endure unrelievable suffering, regardless of their wishes is callous and unseemly. Death is hard enough without being bullied. Like the relief of pain, this too is a matter of mercy."